| 摘要: | CT與MRI都是用途高且高價位的影像診斷工具，它們的使用一直有正反兩面的意見，一方面有人因CT與MR增加疾病診斷而大力推薦，另一方面也有人因為它們的高價位而限制其使用，本篇即針對台灣地區CT與MRI使用總量以及90日內重複使用量與使用率，研究其與醫院層級、疾病類別、治療方法以及開立檢查之醫師的關係，以對這兩種高價位影像診斷儀器的使用提供適切的建議。
在民國93及94年全民健保資料庫的門、急、住診資料中找出所有CT以及MRI的檢查，將其90日內重複使用與否分成兩組，比較前述變項之關係，以SAS 8.2版，羅吉斯迴歸為統計分析之方法，以p＜0.05為統計學有意義之差別。
這兩年中CT與MRI共使用了2,189,894人次，共有462,179人次有90日內重複使用CT及MR，佔總人次21.1%，最多使用在醫學中心，以及財團法人醫院。在地區上，以北區44.66%為最多，重複使用率也以醫學中心為最多。在全部重複使用中，有55.27%在同一家醫院進行。在疾病方面以惡性腫瘤、腦部疾病、診斷困難的症狀群為使用總量前三名，在90日內重複使用人次，則以惡性腫瘤、腦部疾病、骨骼肌肉疾病為前三名，至於重複使用率則以惡性腫瘤、腦血管疾病及感染性疾病為前三名，在全部90日內重複使用人次中有45.95%是因同一種疾病，開刀治療的病患重複使用率高於非手術治療。醫師方面以男醫師、年輕醫師、急診科、神經內、外科及骨科醫師使用量較高，至於重覆使用人次以神經外、神經內及急診科為前三名，重覆使用率以血液腫瘤、放射腫瘤及感染科為前三名。
本研究提供台灣地區CT、MR使用及重覆使用的情形，詳細分析了其與醫院、病患及醫師的關係，可提供醫院自我管理及政策制定者一個很好的參考及指引。
Objective
Both CT and MR can offer patients faster definitive diagnosis and therefore treatment, and are favored by doctors and patients alike. However, their higher profitability also endears them to hospital administration, with the unfortunate side-effect of ever-increasing cost of medical imaging and health waste. In Taiwan, BNHI is a population-based database. The purpose of this study was to assess the association of the hospital characters, diagnosis and physicians in repeated utilization of CT and MR imaging within 90 days based on the National Health Insurance (NHI) database in Taiwan.
Materials and Methods
All CT and MR examinations for inpatient, outpatient and emergency services from 2004-2005 were identified from the database. All repeated scans within 90 days, whether CT or MRI or a combination of both, were noted and recorded.
Logistic regression with generalized estimating equations (GEE) was used for multivariate analysis to explore relationships between diagnosis, hospital, physicians and the repeated utility of CT and MR imaging.
Results
During the years 2004 and 2005, a total of 2,189,894 scans were performed. Among the scans, repeat CT and MRI within 90 days account for 21.10%. And more scans were performed in medical centers and non-profit foundation institutions. The malignancy, brain-related diseases, and musculoskeletal diseases are the most common ailments requiring these imaging modalities, both in terms of absolute number of scans or repeat scans. As to the 90 days repeat scan rate, the malignancy, brain-related disease, and brain, spinal injuries are the highest.
The young doctors, the doctors of emergent room, neurologist, neuro-surgeon, and orthopedics are the most common group of doctors using both the total numbers and repeat CT and MR scans.
Conclusion
These results should be taken into account when healthcare policies are reviewed, so that suitable guidelines can be tailored for different levels of hospitals, different diagnosis, and physicians in order to achieve maximal efficiency for the limited health care budget. |
